|
The
Problem
All
parents of children with asthma and all health professionals involved
in their care are concerned whether asthma or its treatment - in particular
inhaled corticosteroids - impair growth. Previous studies have given conflicting
results which has led to parental concern and professional confusion.
What
did we do?
We
examined height and weight measurements over a 4 year period in 3347 children
with asthma or features suggestive of asthma. We did this by linking 2
simultaneous follow up projects:
Case
records from 12 representative practices from Tayside region were
inspected to determine anti asthma prescribing, including inhaled
corticosteroid dosage, health service utilisation and socio-economic
status (based on 1991 census statistics linked to 6 figure postcodes).
Height
and weight measurements derived independently from the asthma study
using trained personnel and calibrated equipment. Height and Weight
measures were related to population distribution (LMS Scores) and
paired measurements used to calculate growth velocity
What
did we find?
-
Children
who lived in areas of social deprivation (assessed by postcode)
had lower height and weight than their contemporaries (mean SDS
-0.26 (SD 1.02) and -0.18 (1.15) respectively, P<0.001 for both).
-
Children
who were receiving >400m g daily of inhaled steroids and
who were attending both hospital and general practice (a proxy measure
of severity) had lower height and weight than average, independent
of the effect of deprivation (mean SDS -0.62 (1.01), P = 0.002,
for height and -0.58 (0.94), P = 0.005, for weight). These children
showed lower growth rates (mean change in SDS -0.19 (0.51), P =
0.003).
-
No
other groups of children with asthma showed growth impairment.
What
does it mean?
-
Parents
and health professionals can be reassured that the vast majority
of children with asthma have normal growth.
-
Socio-economic
status appears to be the major determinant of growth in children
with asthma, possibly due to sub optimal nutrition or perinatal
growth impairment. High dose inhaled corticosteroid therapy may
be the consequence of, not the cause of, impaired lung development
and growth.
Funding
for this project was from the National Asthma Campaign and
results have been published, giving greater detail, in the BMJ 1998 316
668-672
|
